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When you're 25, the physical aspect of getting pregnant doesn't require much planning or forethought -- you've got the eggs, the estrogen, and the energy. All you need is candlelight and a little Portishead, and presto! Forty weeks later, you're somebody's mother.
But as you enter your 30s, 40s and beyond, Mother Nature makes the job harder.
"There are age-related changes in women's fecundity -- their inherent ability to conceive," said Dr. Paul Miller, a board-certified obstetrician-gynecologist of endocrinology and infertility in the Greenville (S.C.) Hospital system.
He said that in areas of the world where birth control isn't practiced, the pregnancy rate naturally decreases over time in women older than 35, then drops off more rapidly at the age of 40.
For reasons involving ovarian environment and egg quality, a 40-year-old woman has about half the chance of conceiving as her counterparts in their early 20s.
But many women with full lives, delayed marriages and busy careers are putting off childbearing until their 30s or 40s. And some women with children divorce in their 20s, remarry 15 years later and start new broods.
Marisette Hasan, a home health agency nursing administrator, had her first baby at 40 and another at 44. She also suffered two first-trimester miscarriages.
"I got married at 39 and was afraid of getting pregnant on my honeymoon," she said. "My gynecologist at the time said, 'Listen, you're 39; if you get pregnant, it's OK.' "
Hasan's physician prescribed prenatal vitamins and recommended lots of folic acid (to help prevent neural tube defects) just as he would for most other pregnant women.
The only difference in Hasan's case -- and those of most older women -- was an amniocentesis to check for Down's syndrome, and maybe a little extra worrying on her part.
Both of her babies were born healthy.
"Being pregnant was wonderful," Hasan said. "No problems."
Everyone knows that smoking, drinking and drug use are verboten when you start trying to conceive. But what else should you do or stop doing before pouring your hopes, dreams and DNA into a brand-new human being? The fertility checklists on page C3 provide a good, basic overview.
Miller's research in weight-related fertility problems is of particular interest.
"Women more than 30 percent over their ideal body weight often have a hard time getting pregnant," he said. Women who eat restrictively, exercise excessively and are more than 10 percent under their ideal body weight have the same difficulty.
It makes perfect evolutionary sense, he said -- nature encourages pregnancy in women who have the energy and ability to sustain its metabolic demands.
He recommends moderate exercise for all women -- it's great for stress reduction as well as weight control. Counseling and acupuncture have helped some women, too.
"The bottom line is moderation in all things," he said.
Dr. Fred Shipley, an OB-GYN and director of the Diagnostic Center for Women in Columbia, specializes in high-risk pregnancy. He says that women older than 30 have several secret weapons their younger counterparts don't.
"Women of 30, 35 and older -- most of them are a lot smarter and pretty well-educated," he said. "They're easier to take care of because they've done research -- the Web, books. They're knowledgeable; smarter about it all in general. Whereas a 22-year-old will often wake up pregnant and ask, 'I missed my period. What does this mean?' "
Another side effect of conceiving in your 30s or 40s is the higher possibility of multiple births, even without fertility treatment.
"Older women's ovulation is not as snappy as it was when they were younger, so they have more probability of multiple eggs," Shipley said.
One of his patients, 34-year-old Isabel Lefaivre of Columbia, is now expecting triplets.
"It was quite a surprise," Lefaivre said.
She and her husband also have two daughters, ages 3 and 5. Her second baby, and the triplets, were conceived with the help of fertility drug Clomid.
Lefaivre first took Clomid when she didn't conceive her second baby as quickly as she had expected.
"I thought it was unusual because we got pregnant so quickly with my first one, so we kind of raised an eyebrow," she said. "Luckily I had a great doctor who was right on, and he said, 'Let's not waste any more time.' A lot of women wait up to a year, trying and trying and trying, but I'd say go in and talk to your doctor after six months."
The only difference between her earlier pregnancies and this one is that she's exercising less. She doesn't feel much like getting on the treadmill or the stationary bike these days.
"I've just been taking it easy," she said of preparing for her triplets' birth. "You can choose to lose heart and panic, or you can choose to stay on the positive side. I've chosen to take it one day at a time and stay positive."
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